Laserfiche WebLink
09/09/2009 WED 11:04 FAX 200A':R3433 SJC EHD --- Stockton Sery Sta Ea Cc 2008/008 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: WWW.Sj og V.org <br />FACILITY NAME <br />FACILITY CONTACT NAME <br />CLOSURE FEE = $345 / TANK <br />2004 <br />FACILITY hDDRESS <br />SITE PHONE # WI H AREA CODE <br />/ ill - ® <br />ce% <br />CITY <br />STATE <br />ZIP CODE # OF TANKS AT SITE <br />$ <br />CA <br />APPLICAN <br />NAME <br />CLOSURE FEE = $345 / TANK <br />2004 <br />APPLICANT NAME <br /><7J'(Cll".\� \[. Z.J II.1"J: <br />( i Yom, �'-t., <br />/ . l•. <br />( <br />/CONTACT <br />�1 J..1;- �K.1 �./`� <br />APPLICANT MAILING ADDRESS <br />$ <br />APPLICANT # WITH AREA CODE <br />l: l.� 1 t <br />I ), r <br />� <br />1 <br />iP/HONE <br />�( �16I �� ti — <br />CITY <br />STATE <br />ZIP CODE <br />CIRCLE WORK T E DONE <br />CONTRACTOR ICC # <br />$ <br />Closure Installat) n Repair Rotrofit <br />S� <br />ACTIVE FACILITY <br />TANK ID # (s): <br />CLOSURE FEE = $345 / TANK <br />2004 <br />zoos <br />Zoos <br />200 <br />Zoos <br />Zoos <br />$500 FEE INCLUDES FACILITY FEE + 1 TANK (2004-2007) <br />$ <br />PIPING REPAIR FEE = $345 / FACILITY use for piping, under -dispenser containment, act. <br />$ <br />SAMPLING INSPECTION FEE _ $ 1151 HOUR <br />$550 FEE INCLUDES FACILITY FEE + 1 TANK (2008-2009) <br />$125 PER TANK AFTER FIRST TANK <br />$ <br />TANK PENALTY ASSESSED <br />TANK SURCHARGE = $15 / TANK <br />$ <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$49.00/ FACILITY <br />PERMANENT CLOSURE <br />Removal or Permitted Closure in Place <br />TANK ID # (s): <br />CLOSURE FEE = $345 / TANK <br />I # TANKS X $345 = <br />TEMPORARY CLOSURE <br />Plan Review and Inspections) <br />TANK ID # (s) : <br />TEMPORARY CLOSURE FEE = $345 / FACILITY <br />%LLATION PLAN CHECK <br />Check and Construction Ir <br />TANK ID # (s) : I PLAN CHECK FEE =_$920 / FACILITY <br />REPAIR PLAN CHECK <br />TANK ID # (s) <br />TRANSFER FEE _ $ 20 <br />$ <br />TANK RETROFIT REPAIR FEE = $345 / FACILITY (use for monitoring equipment, cold starts, EVR upgrades, <br />$ <br />spill buckets, sumps. misc. <br />$ <br />PIPING REPAIR FEE = $345 / FACILITY use for piping, under -dispenser containment, act. <br />MISCELLANEOUS <br />TRANSFER FEE _ $ 20 <br />$ <br />CONSULTATION FEE _ $ 115/ HOUR <br />$ <br />UNAUTHORIZED RELEASE EVALUATION FEE = $ 115 /HOUR <br />$ <br />SAMPLING INSPECTION FEE _ $ 1151 HOUR <br />ALL FEES ARE BASED ON THE $115 HUUHLY HAI C. I IMC IHAI rAGceua rrr0 rA1U VV1LL 0c 01U�Cv iv nrrui.i+n i. <br />AIZMf`F I ICF OMI V <br />SERVICE REQUEST # FACILITY ID AMOUNT RECEIVED CHECK # RECEIVED BY DATE RECEIVED <br />SR <br />EH 23 032 (REVISED 07/01/09) <br />